The Mentally Disabled Women: Sterilization at the Request of Others
On December 13, 2006, the United Nations General Assembly,as reported in the
International Herald Tribune approved the “first convention protecting rights of world’s 600 million disabled people.” According to the article,the convention “guarantees that the disabled have the inherent right to life on an equal basis with the able-bodied and requires countries to prohibit discrimination on the basis of disability and guarantee equal legal protection. Countries must also ensure the equal right of the disabled to own and inherit property, to control their financial affairs, and to privacy over their personal lives.” The convention will enter into force when it is ratified by 20 countries. One of the issues that concern disability activists is the “forced sterilization of girls and women because of their disability, forced institutionalization and substitute decision making.”
It is my understanding that governmental ordered (forced) permanent sterilization of mentally disabled women in the United States has been abolished in the past several decades. Sterilization, to prevent pregnancy, of a woman who is mentally unable to provide informed consent varies in the different states but can be performed only on the direct request of a legal guardian with physician recommendation and/or court approval. The obvious medical rationale for performing such a procedure would be to prevent harm if further pregnancy or delivery would endanger the life or health of the mother. However, if this is not the case, the social rationale would be to prevent harm to the child if the mother is mentally unable to provide appropriate care or as a consequence of the pregnancy an unnecessary burden placed on society or the guardian with regard to the financial or other responsibilities to care for the child. Another social argument would be to prevent any genetic basis for the mental handicap to be passed on to future generations—eugenics. The latter argument for mandatory sterilization, as originally approved by the Supreme Court in 1927, was overturned in 1942 by the Court.
Here is the ethical issue to my visitors: Do you find any excuse for the permanent sterilization of a mentally disabled woman ethical on the basis of a decision by others without the woman’s own personal and informed consent? How about non-surgical, non-permanent contraceptive medication use without consent? ..Maurice.
posted by Maurice Bernstein, M.D. @ 8:56:00 AM
11 comments
11 Comments:
mentally challendged people should have the right have children even if the society has to pay for it,
Do the mentally challenged have a right to have children if they do not even understand what that means? There was an earlier discussion on this blog about parents who stopped a child's growth so as to best be able to care for her at age 6 -- a severely mentally disabled child.
If a woman is too mentally disabled to understand and consent to the physical condition of pregnancy; if she is not able to understand herself how to avoid pregnancy, and if she is likely to be unable to prepares physically or mentally for childbirth (thus finding it traumatic), I think there is an argument for sterilization at the behest of the caregiver and in consultation with medical professionals. It is ethical because it is in the best interests of the patient not to put her through childbirth or pregnancy, which would be incomprehensible and frightening.
In this instance, and in this instance only, I would consider sterilisation. I would not advocate the long term use of medical birth control because it would seem the side effect profile over a long term would cancel out the benefits of "being in the best interests of the patient".
Dr. Bernstein, the first thing I would want to do is ensure that the woman in question is truly is unable to deal with her own life issues, or make her own choices ... I've seen labels and definitions applied rather creatively in the past ...
Secondly, if the question is one which would affect the woman permanently, I would want to be certain that the woman's "disability" is permanent, and not one that she could conceivably recover from in the future.
Once those criteria are established, I don't believe that the potential mother should be put through the trauma of a childbirth ... and it would also be unfair to the child, on several levels.
Contraception at the request of others in the above circumstances is one thing. Sterilization is a bit more serious, and would be traumatic on its own, and I think should be avoided if possible. Once a child is conceived, however, I believe that it should be given a chance at life.
I have worked with severe/profoundly cognnitively impaired children/young adults for 7 years. Many of the females are put on some form of birth control by their parents or legal guardians. When this happens, it is for the same medical reasons that a non-disabled female would be placed on birth control (highly irregular menses, extemely heavy periods, extreme moodiness/PMS around menses). I do not think this is unethical.
Nobody is thinking about the life of the poor child that is born and has to suffer through the trauma of growing up and dealing with the stress of an unwilling society that does not accept them, it is not their fault.
I FEEL THAT THE CHILD WILL STILL BE BROUGHT UP WITH AS MUCH LOVE AS A ABLE BODIED PERSON.THIER DISIBILITY SHOULDNT HINDER THEM FROM EXPERIENCING THE JOYS OF A CHILD BIRTH.IM POSITIVELY SURE THEYLL HAVE HELP AND SOCIETY WILL SEE IT AS A START AND THEY SHOULD BE ABLE TO LIVE A HAPPY NORMAL LIFE WITH THEIR CHILD.
I truly believe that no child should live with someone like my very close relative who is mentally challenged. She wanted to have a cat so she got one. The cat is still afraid of her, hiding whenever she is around. Just imagine for a second that Mambo is a child...We should hold the hand of people in need but we should also make it sure that people who are disabled mentally and has no sense of responsibility are not reproducing. It can be very dangerous and a risk is not a chance to take. Sterilisation should be a must when it appropriate.
I understand the compassionate cry of those who would not want to deny a disabled woman the wonders of having and raising a child. However, as a parent of a mentally disabled young woman, I am panicked to think of my daughter raising a child. She can just barely care for her most basic physical needs, never mind about her emotional ones. The baby/child would not be safe with her alone, and it's already a full time job for us to look out for her. Having a baby would push us (and the ever dwindling mental health system) over the edge. Honestly, it makes me angry to hear arguments assuming that "she'll be taken care of." By whom?!
Those who have come to this thread may be interested in reading a more recent thread where a case is discussed regarding the parents of a "profoundly cognitively impaired 20-year-old daughter" whom they cared for at home "asked that their daughter’s ovaries be stimulated so her eggs could be harvested for fertilization with donor sperm and the resulting embryos brought to term by a contract birth-giver. They would then rear their grandchild themselves." Neither of the parents were capable of producing more children. They wanted their daughter to have a child for reasons of wanting to keep the family line intact.
If you want to write your opinion about that case, to maintain continuity, go to the above link and write your comments there. ..Maurice.
Ok.... the thing is, i believe there needs to be a criteria that needs to be fulfilled in order for people with mentally impaired diseases to have offspring. These criteria need to make sure the said person can fully fathom the idea of pregnancy, childbirth, proper care of a child, and the ability to UNDERSTAND the ramifications of introducing life into this world. The person(s) also need(s) to realize that by bringing this child into the world, they are condemning it into to a life of hardship and a world that does not fully accept it.
Just a thought from a 16 year old boy.
I actually just stumbled across this debate in trying to find help for my friends. They have a 13 year-old daughter with severe autism and down syndrome. She will never be able to speak, she still isn't potty trained, and she will never be able to lead a "normal" life.
I did behavioral therapy with her for two years, and she's also had some excellent behaviorists, speech pathologists, and OTs working with her. The thing is that despite all this help, she still doesn't and never will have a very good grasp on proper social comportment, let alone the more complex issues of conception and child raising. I'm looking for some way that my friends can get sterilization so she doesn't have to endure the indignity of dealing with bloody diapers every month.
I'm definitely pro-life, but any person who spends even ten minutes with this girl can tell that she will never be having children. This is a case where her "reproductive rights" will cause her more social stigma (if, as is likely, she has incidences of exposing bloody diapers to people or doing other socially inappropriate things) and a lower quality of life (how do you explain menstruation to someone who doesn't understand potty training?) than if her parents were allowed to get her sterilized.
I understand and agree that this issue should be approached with compassion and others' best interests at heart, but in this case that would mean sterilization for this little girl. As a concerned friend of this family, I would love for them to not have to fight an uphill legal battle to ensure that their daughter has a better life. Does anyone know of any solutions?
JB
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